Division of Gynecologic Oncology, University of Toronto, Toronto, Ontario, Canada.
Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada.
Int J Gynecol Cancer. 2023 Jul 3;33(7):1077-1082. doi: 10.1136/ijgc-2022-004202.
We previously developed the Integrated Prediction Model using a 4-step algorithm of unresectable stage IVB, patient factors, surgical resectability, and surgical complexity to predict outcome of <1 cm cytoreduction in advanced epithelial ovarian cancer, and triaged patients to neoadjuvant chemotherapy or primary cytoreductive surgery.
To validate the Integrated Prediction Model on a retrospective cohort of patients.
A retrospective cohort study of 107 patients with advanced ovarian cancer treated between January 2017 and September 2018 was carried out. The above mentioned 4-step algorithm determined cut-off points using the Youden Index. This validation study reports sensitivity, specificity, negative and positive predictive value on an external cohort.
Among 107 patients, 61 had primary surgery and 46 had neoadjuvant chemotherapy. Compared with primary surgery, patients treated with neoadjuvant chemotherapy were significantly older (63.5 vs 61, p=0.037), more likely to have stage IV disease (52% vs 18%, p<0.001), Eastern Cooperative Oncology Group (ECOG) score >1 (30% vs 11%, 0.045), lower pre-operative albumin (37 vs 40, p<0.001), and higher CA-125 (970 vs 227.5, p<0.001). They also had higher patient factors (2 vs 0, p=0.013), surgical resectability (4 vs 1, p<0.001), and anticipated surgical complexity (8 vs 5, p<0.001). There was no significant difference in outcome of cytoreduction (<1 cm residual disease: 85% for primary surgery vs 87% interval surgery, p=0.12)In this validation cohort, triaging patients with patient factors ≤2, surgical resectability score ≤5, and surgical complexity score ≤9 to primary surgery had a sensitivity of 91% for optimal cytoreduction <1 cm and a specificity of 81%. The positive predictive value, negative predictive value, and accuracy were 83%, 90%, and 86%, respectively. Application of the Integrated Prediction Model would have prevented five patients from receiving suboptimal cytoreduction and triaged them to neoadjuvant chemotherapy.
We validated the proposal that a triage algorithm integrating patient factors, surgical complexity, and surgical resectability in advanced ovarian cancer had high sensitivity and specificity to predict optimal cytoreduction <1 cm.
我们之前开发了一种综合预测模型，该模型采用 4 步算法对不可切除的 IVB 期、患者因素、手术可切除性和手术复杂性进行分析，以预测晚期上皮性卵巢癌 1cm 减瘤术的结果，并将患者分诊至新辅助化疗或原发性细胞减灭术。
在晚期卵巢癌患者的回顾性队列中验证综合预测模型。
对 2017 年 1 月至 2018 年 9 月期间治疗的 107 例晚期卵巢癌患者进行回顾性队列研究。上述 4 步算法使用约登指数确定截断点。本验证研究报告了外部队列的敏感性、特异性、阴性预测值和阳性预测值。
在 107 例患者中，61 例患者接受了原发性手术，46 例患者接受了新辅助化疗。与原发性手术相比，接受新辅助化疗的患者年龄明显较大（63.5 岁 vs 61 岁，p=0.037），IV 期疾病比例更高（52% vs 18%，p<0.001），东部肿瘤协作组（ECOG）评分>1（30% vs 11%，0.045），术前白蛋白水平较低（37 vs 40，p<0.001），CA-125 水平较高（970 vs 227.5，p<0.001）。他们的患者因素（2 分 vs 0 分，p=0.013）、手术可切除性（4 分 vs 1 分，p<0.001）和预期手术复杂性（8 分 vs 5 分，p<0.001）也更高。两组在减瘤术结果（<1cm 残留疾病：原发性手术 85% vs 间隔手术 87%，p=0.12）方面无显著差异。在这个验证队列中，将患者因素≤2、手术可切除性评分≤5 和手术复杂性评分≤9 的患者分诊至原发性手术，其最佳减瘤术<1cm 的敏感性为 91%，特异性为 81%。阳性预测值、阴性预测值和准确性分别为 83%、90%和 86%。综合预测模型的应用可以防止 5 名患者接受次优减瘤术，并将他们分诊至新辅助化疗。
本研究验证了一种将患者因素、手术复杂性和手术可切除性整合到晚期卵巢癌中的分诊算法，该算法具有较高的敏感性和特异性，可预测最佳<1cm 减瘤术。
